This study examined how doulas adapt to challenges in client’s labors. There were 104 Canadian and 92 American doulas who responded to a survey distributed at a doula conference. We report results from open-ended questions in which doulas describe how they manage changes deviating from the mother’s birth plan and how they navigate differences of opinion between themselves and providers. Four themes emerged: giving nonjudgmental support, assisting informed decision making, acting as a facilitator, and issues with advocacy. Although 30% of doulas said that advocacy and information giving could result in conflict with providers, doulas reported working within their scope of practice and striving to be part of the team. Issues in doula responsibility and patient advocacy remain, and ongoing role clarification is needed.

This recent article in the Journal of Perinatal Education focuses on how doulas help women adapt to unexpected changes in their birth plan during labor. The authors surveyed doulas attending a DONA International conference in Vancouver, Canada in 2008. In terms of interactions with care providers, the authors found that doulas acted according to the DONA International standard of practice.

According to the doulas surveyed, “support” does not mean supporting women through one set birth path, but supporting them through any turn labor may take and respecting the decisions of all others involved in the process. The Maternity Support Survey found that doulas were more likely than other support workers to have strong opinions about common labor practices such as epidurals, induction, and the use of Pitocin. Yet, the authors of this article found that doulas surveyed were able to put aside their personal opinions and focus on the desires of the women they serve.